Timely diagnosis of hearing loss in children has significant implications for a child's social and cognitive development. In young children, hearing loss is often inconspicuous resulting in delayed diagnosis and rehabilitation. As a result, children are at increased risk of delayed speech acquisition and the subsequent long-term sequelae. Speech delay and hearing loss also represents a significant cost to society due to the resources required for their treatment, such as special education, speech therapy, and social services. However, it is clear that early detection is the key to restoring normal speech development and a favorable long-term outcome.
Definitive diagnosis of hearing loss is typically made through audiologic assessment of pure-tone air, bone and speech thresholds. Traditionally, pure-tone thresholds are documented by asking the subject if they can hear tones of varying frequency and intensity. Currently, standard clinical audiometry is performed using expensive, proprietary, non-portable hardware and access is therefore limited in developing countries, where hearing loss is more prevalent.
Automation of pure-tone audiometry offers several potential benefits. Particularly, a portable, automated audiometer improves accessibility, creating the possibility of routine pure-tone audiometry in the primary care setting or in remote communities. Such a device may eventually permit a parent or teacher access to screening audiometry, resulting in earlier detection of hearing impairment. However, there may be significant differences between mean hearing thresholds determined though automated audiometry and manual audiometry. As such, clinical validation of any automated audiometer is a necessity.
Pure-tone audiometry, regardless of automation or lack thereof, is a mundane task. It is especially challenging to perform in the pediatric population where short attention span and the extent of cognitive development can be limiting factors. Children with hearing impairment may find audiometric testing even more difficult. Several adaptations of pure-tone audiometry are used to evaluate hearing in children. These techniques include behavioral observation, visual re-enforcement, and conditioned play audiometry. While more successful than conventional pure-tone audiometry, these adaptations are resource intensive and typically require two specially trained audiologists to administer. Naturally, an ideal solution would capitalize on the advantages of automation, while maintaining clinical validity and age appropriateness.
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